Abstract
Introduction: Although guidelines state that CPR efforts may be withheld in adult, blunt trauma patients, who are found apneic and pulseless upon EMS arrival, there are conflicting reports on the utility of CPR in injured children. The purpose of this study was to determine the outcomes of pediatric blunt trauma patients who received CPR.
Methods: A prospectively gathered registry at a Level I university pediatric trauma center was reviewed over ten years. 11,563 trauma patients were evaluated of which 225 (1.9%) received CPR. 117 patients were excluded because of asphyxial injuries or penetrating trauma, leaving 108 (48.0%) patients for analysis.
Results: 108 blunt trauma patients received CPR by trained personnel. The mean age was 5.5 years, mean ISS of 40.1, and the three most common injury mechanisms were MVC (n = 29), pedestrian (n = 24), and assault (n = 21). Thirteen (13%) of those who died went on to organ donation. The single survivor (0.9%), an assault victim, was found unresponsive after 20 minutes, then received CPR for 30 minutes before return of pulse. Two years post-injury this patient is ventilator and tube feeding dependent due to a persistent vegetative state.
Conclusions: The utility of CPR in pediatric blunt trauma patients, when done for cardiopulmonary arrest, is limited. As per ATLS® guidelines, an adequate airway should be established and potentially reversible causes should be treated. If there is no return of pulse, then efforts should be terminated, unless organ donation is contemplated.